Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment

Jo, Eun-Jung; Yang, Min‐Suk; Kim, Yoon Jeong; Kim, Hyunsuk; Kim, Mi‐Yeong; Kim, Sae Hoon; Cho, Sang Heon; Min, Kyung-Up; Chang, Yoon-Seok

doi:10.5415/apallergy.2012.2.2.161

Cited by 27 publications

(17 citation statements)

References 16 publications

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“…A few cases of WIA, which were enhanced by aspirin or nonsteroidal anti-inflammatory drugs, have been reported in adult patients [9]. Recently, it has also been reported that FDEIA could be dependent on the temperature [10]. In this study, all of the cases of WIA were adult-onset and 4 (67%) of the patients had co-morbid allergic diseases.…”

Section: Discussionmentioning

confidence: 47%

Wheat-Induced Anaphylaxis in Korean Adults: A Report of 6 Cases

Lee

et al. 2013

Clin Nutr Res

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Wheat is a common cause of food allergy. Wheat-induced anaphylaxis (WIA) and wheat-dependent exercise induced anaphylaxis (WDEIA) are severe forms of immunoglobulin E (IgE) mediated allergic reaction to wheat protein. As the diagnosis of WIA or WDEIA is not easy because of the risk of oral challenge, identification of specific IgE of various wheat proteins is helpful for diagnosis. In Korea, there are only a few reports on WIA in adults. We report six cases of WIA diagnosed on the basis of clinical history and specific IgE of wheat proteins or provocation test. For immunologic evaluation of severe wheat allergy including WIA and WDEIA, it is important to measure specific IgE to each component of wheat including gluten and ω-5 gliadin not just measuring wheat-specific IgE.

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Section: Discussionmentioning

confidence: 47%

Wheat-Induced Anaphylaxis in Korean Adults: A Report of 6 Cases

Lee

et al. 2013

Clin Nutr Res

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“…The equilibrium of the body temperature seems to have a narrow range. A cold environment or a warm environment may augment severe allergic reactions. The pathophysiology of these conditions is unclear.…”

Section: Common Augmenting Factorsmentioning

confidence: 99%

Factors augmenting allergic reactions

Niggemann

Beyer

2014

Allergy

101

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Elicitors of anaphylactic reactions are any sources of protein with allergenic capacity. However, not all allergic reactions end up in the most severe form of anaphylaxis. Augmenting factors may explain why certain conditions lead to anaphylaxis. Augmenting factors may exhibit three effects: lowering the threshold, increasing the severity, and reversing acquired clinical tolerance. Common augmenting factors are physical exercise, menstruation, NSAIDs, alcohol, body temperature, acute infections, and antacids. Therapeutic options may address causative, preventive, pragmatic, or symptomatic considerations: avoid the eliciting food, take an antihistamine before any situation with a possible risk of augmentation, separate food and sport (at least for 2 h), and carry an adrenaline autoinjector at all times. Individual patterns include summation effects and specific patterns. In conclusion, in the case of a suggestive history but a negative oral challenge, one should consider the possible involvement of augmenting factors; after anaphylactic reactions, always ask for possible augmentation and other risk factors during the recent past; if augmentation is suspected, oral food challenges should be performed in combination with augmenting factors; and in the future, standardized challenge protocols including augmenting factors should be established.

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“…It is similarly rare that anaphylaxis is elicited only if two different foods are simultaneously ingested 37,72. Other cofactors needed to cause anaphylaxis from physical exercise have been identified in exposure to warm58 or cold temperature,40 menstrual cycle,28 metal-containing dental amalgams,73 and drug intake, especially NSAIDs. In Table 2, we summarize FDEIAn cofactors reported in the literature.…”

Section: Clinical Characteristics Of Eianmentioning

confidence: 99%

“…Still, the test may give false-negative results 43. The need of concomitant factors, such as cold or warm temperature58,40 or other particular characteristics of the environment where EIAn occurred, may partly account for such outcome 16. Also, in 34 patients with wheat-dependent EIAn, a positive challenge was obtained only by using oral gluten flour (four patients) or gluten plus consumption of acetylsalicylic acid and alcohol as cofactors (ten patients), which were associated with significantly increased plasma gliadin levels 68.…”

Section: In Vivo Testingmentioning

confidence: 99%

Diagnosis of exercise-induced anaphylaxis: current insights

Pravettoni¹,

Incorvaia²

2016

JAA

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Exercise-induced anaphylaxis (EIAn) is defined as the occurrence of anaphylactic symptoms (skin, respiratory, gastrointestinal, and cardiovascular symptoms) after physical activity. In about a third of cases, cofactors, such as food intake, temperature (warm or cold), and drugs (especially nonsteroidal anti-inflammatory drugs) can be identified. When the associated cofactor is food ingestion, the correct diagnosis is food-dependent EIAn (FDEIAn). The literature describes numerous reports of FDEIAn after intake of very different foods, from vegetables and nuts to meats and seafood. One of the best-characterized types of FDEIAn is that due to ω5-gliadin of wheat, though cases of FDEIAn after wheat ingestion by sensitization to wheat lipid transfer protien (LTP) are described. Some pathophysiological mechanisms underlying EIAn have been hypothesized, such as increase/alteration in gastrointestinal permeability, alteration of tissue transglutaminase promoting IgE cross-linking, enhanced expression of cytokines, redistribution of blood during physical exercise leading to altered mast-cell degranulation, and also changes in the acid–base balance. Nevertheless, until now, none of these hypotheses has been validated. The diagnosis of EIAn and FDEIAn is achieved by means of a challenge, with physical exercise alone for EIAn, and with the assumption of the suspected food followed by physical exercise for FDEIAn; in cases of doubtful results, a double-blind placebo-controlled combined food–exercise challenge should be performed. The prevention of this particular kind of anaphylaxis is the avoidance of the specific trigger, ie, physical exercise for EIAn, the assumption of the culprit food before exercise for FDEIAn, and in general the avoidance of the recognized cofactors. Patients must be supplied with an epinephrine autoinjector, as epinephrine has been clearly recognized as the first-line intervention for anaphylaxis.

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Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment

Cited by 27 publications

References 16 publications

Wheat-Induced Anaphylaxis in Korean Adults: A Report of 6 Cases

Wheat-Induced Anaphylaxis in Korean Adults: A Report of 6 Cases

Factors augmenting allergic reactions

Diagnosis of exercise-induced anaphylaxis: current insights

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